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Minimally-invasive liver resection in pediatric patients: initial experience and outcomes
Michelle A Veenstra1, Alan J Koffron1
1Oakland University, William Beaumont School of Medicine, Beaumont Health Systems, Department of Surgery, Division of Pediatric Surgery, USA.
Background:
Minimally Invasive Liver Resection (MILR) is an evolving procedure in the adult population for benign and malignant lesions, offering less morbidity while maintaining acceptable outcomes. However, there lacks a published MILR experience in the pediatric population besides case reports. This report describes a pediatric MILR experience in terms of pathology, clinical specifics, and patient outcomes.
Methods:
This is a retrospective review of 36 pediatric patients undergoing MILR for benign and malignant conditions. MILR was performed by pure laparoscopy, hand-assisted laparoscopy, and a hybrid laparoscopic assisted method. Data points reviewed include patient demographics, pathology, operative technique, complications, and recurrence.
Results:
Patients with benign (15) and malignant (21) conditions underwent segmentectomy, sectionectomy, or hemihepatectomy by MILR. Thirty-one were completed with pure laparoscopy and 20 underwent hemihepatectomy. Operative time and blood loss correlated with magnitude of resection with five patients requiring a blood transfusion. Complications were minor and included a seroma, port infection, port dehiscence, line infection, and hypertrophic scar. At median follow-up of 12 months (range 6-36 months), there were no mortalities, re-operations, or recurrences.
Discussion:
MILR can be performed in pediatric patients for benign and malignant conditions with good technical and oncologic outcomes and low morbidity.
Insights
Minimally Invasive Liver Resection (MILR) is safe and effective in pediatric patients for both benign and malignant conditions. This approach offers good outcomes with low morbidity, establishing its value in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hepatobiliary Surgery
Background:
- Minimally Invasive Liver Resection (MILR) is established in adults but underreported in pediatrics.
- Existing pediatric MILR data is limited to case reports.
Purpose of the Study:
- To describe the pediatric experience with MILR.
- To analyze pathology, clinical details, and outcomes of pediatric MILR.
Main Methods:
- Retrospective review of 36 pediatric patients undergoing MILR.
- Procedures included pure laparoscopy, hand-assisted, and hybrid techniques.
- Data collected on demographics, pathology, operative details, complications, and recurrence.
Main Results:
- MILR performed for 15 benign and 21 malignant conditions.
- Resections included segmentectomy, sectionectomy, and hemihepatectomy.
- Low complication rate (seroma, infections, scar); no mortalities, re-operations, or recurrences at 12-month median follow-up.
Conclusions:
- MILR is technically feasible in pediatric patients for diverse liver conditions.
- Pediatric MILR demonstrates favorable oncologic and clinical outcomes.
- The procedure is associated with low morbidity in the pediatric population.
